Презентация на тему Breast cancer

Breast cancer

The most frequent cancer in women

Ashkenazi Jewish 1:40, compared with 1:500 in the general population

+ prostate and pancreatic

Cowden’s syndrome

Hamartomas on the skin and mucous membranes.
Enlarged head, a rare noncancerous brain tumor called  Lhermitte–Duclos disease

Irradiation for the treatment of Hodgkin lymphoma before age 30 years.

Magnitude of Risk of Known Breast Cancer Risk Factors

+ PBSO

Prevention for BRCA patients

Tam ↓contralater - 40-50%,
↓ Risk BC in unaffected only in BRCA 2 (started from age 35)
PBSO -↓OC up to 90-%.
↓ BC -50% (before age 50)
BME ↓ BC 90%

Chemoprevention with Tamoxifen

+

RR 50% (0.51) (47 treated - 1 BC prevented)
ADH - RR 84%
LCIS – RR 40%


↓ 30% bone fructures

-

PE (>50y)
Flashes
Endometrial Ca (mostly >50y)

BC Receptors

BC Receptors

Biological subtypes

Staging

DS

Mammography
US

MRI

CT (chest/abdomen)
Bone scan or PET CT
CT/MRI head
Tumor markers

Systemic therapy:
Hormonal therapy
Chemotherapy
Targeted therapies

Local therapy:
Surgery
Radiation therapy

Treatment of breast cancer

Surgery

In the patient with clinical stage I, II, and T3N1 disease, the initial management is usually surgical.
BCT : Lumpectomy + RT = Mastectomy
Contraindications for BCT:
- Previous RT
Pregnancy
Widespread disease
Pos margins
Tumors >5 cm, small breast

Axilla

ALND
SLNB (less lymphedema)
- Majority of stage I-II BC pts
- Contraindications to the procedure: pregnancy, lactation, and locally advanced breast cancer.

Adjuvant radiation therapy:

5 - 6.5 weeks
Local control rates > 90%
Minimal toxicity

Adjuvant radiation therapy – for everyone after
lumpectomy

Postmastectomy RT

All women with > 3 positive nodes.

All women with any positive node and a tumor larger than 5 cm.

Women with recurrent positive margins

? Women with T3N0

? Women with 1-3 positive nodes and T1/T2.

For 1 year every 3 weeks

Neoadjuvant chemotherapy

Indications

T4
cN pos
Inflamatory BC

Rationale

Tumor shrinkage
Opportunity for BCS
Early treating of micrometastasis
Aggressive biological subtypes ---- high rate of PCR (associated with better prognosis)

Herceptin +/- Pergeta (Trastuzumab+/- Pertuzumab) & CMT

Her 2 pos BC

Lapatinib

Her 2 pos BC
A tyrosine kinase inhibitor
A potent and selective oral dual inhibitor of ErbB1 (EGFR) and ErbB2 (HER2)
Approved by FDA March 13, 2007
In combination with capecitabine

Trastuzumab emtansine (TDM1= KADCYLA)

Her 2 pos BC

Trastuzumab emtansine

Inflammatory BC

T4
1% to 5% of all cases
Aggressive
Neoadjuvant CMT +/- RT
Surgery is contraindicated in IBC unless there is complete resolution of the inflammatory skin changes. 

Paget disease

 1 to 4.3% of all breast cancers
Ca in situ in the nipple epidermis.
Paget cells (large cells with clear cytoplasm and atypical nuclei) within the epidermis of the nipple. 
(1) associated with invasive cancer (staged by the invasive cancer)
(2) with underlying DCIS (Tis)
(3) alone (Tis). 

Thank you.